The impact of in-service physical injury or illness on the mental health of military veterans

BACKGROUND

Each year approximately 2000 UK service personnel are medically discharged with physical and/or psychological injury or illness. While there is much research on both psychological injury and physical injury, the challenges of transition relating to the intersection between the two has received less attention. This article reports on the first phase of a 2-year funded study with the aim to understand the lived experiences of veterans who have been discharged from service with a physical injury or illness and the impacts of this on their mental health.

METHODS

Using a qualitative methodology, 22 veterans who had been discharged from service within the last 8 years were interviewed to identify key aspects of their experience of the transition process.

RESULTS

The article highlights two key themes: how some veterans adjusted to life with a physical injury or condition; and, the intersections that became apparent between physical injury and mental health. The challenges that veterans faced were shaped by the transition process and by the way in which the medical discharge process was conducted.

CONCLUSIONS

Consideration of improvements to the medical discharge process could influence better outcomes for those who have left with a physical injury or illness and later find themselves struggling with mental health issues.

The Micronemal Plasmodium Proteins P36 and P52 Act in Concert to Establish the Replication-Permissive Compartment Within Infected Hepatocytes

Within the liver, Plasmodium sporozoites traverse cells searching for a "suitable" hepatocyte, invading these cells through a process that results in the formation of a parasitophorous vacuole (PV), within which the parasite undergoes intracellular replication as a liver stage. It was previously established that two members of the Plasmodium s48/45 protein family, P36 and P52, are essential for productive invasion of host hepatocytes by sporozoites as their simultaneous deletion results in growth-arrested parasites that lack a PV. Recent studies point toward a pathway of entry possibly involving the interaction of P36 with hepatocyte receptors EphA2, CD81, and SR-B1. However, the relationship between P36 and P52 during sporozoite invasion remains unknown. Here we show that parasites with a single P52 or P36 gene deletion each lack a PV after hepatocyte invasion, thereby pheno-copying the lack of a PV observed for the P52/P36 dual gene deletion parasite line. This indicates that both proteins are equally important in the establishment of a PV and act in the same pathway. We created a Plasmodium yoelii P36mCherry tagged parasite line that allowed us to visualize the subcellular localization of P36 and found that it partially co-localizes with P52 in the sporozoite secretory microneme organelles. Furthermore, through co-immunoprecipitation studies in vivo, we determined that P36 and P52 form a protein complex in sporozoites, indicating a concerted function for both proteins within the PV formation pathway. However, upon sporozoite stimulation, only P36 was released as a secreted protein while P52 was not. Our results support a model in which the putatively glycosylphosphatidylinositol (GPI)-anchored P52 may serve as a scaffold to facilitate the interaction of secreted P36 with the host cell during sporozoite invasion of hepatocytes.

Mast cells in infantile haemangioma possess a primitive myeloid phenotype

AIMS

Recent reports on infantile haemangioma (IH) have demonstrated a primitive population of interstitial cells expressing the embryonic transcription factor, Nanog, with decreasing abundance during involution. In this report we investigated the expression of Nanog on mast cells in all three phases of IH progression.

METHODS

Paraffin-embedded sections of six proliferating, six involuting and six involuted IH lesions were used to investigate the expression of tryptase, Nanog, CD45, CD34 and GLUT-1 by immunostaining.

RESULTS

Mast cells, identified by their expression of tryptase, were located in the interstitium of IH lesions. 93%, 42% and 0% of these tryptase(+) cells also expressed Nanog, in proliferating, involuting and involuted IH, respectively.

CONCLUSIONS

The identification of an abundant population of tryptase(+)/Nanog(+) cells in IH is novel. The relative loss of Nanog expression as IH involutes may be a result of maturation and/or proliferation of these cells. This report supports the primitive nature of IH.

Verrucous hemangioma expresses primitive markers

BACKGROUND

Verrucous hemangioma (VH) presents clinically as a vascular malformation but has similar histopathologic features to infantile hemangioma. This study characterized the cell population within VH.

MATERIAL AND METHODS

Paraffin-embedded sections from two male patients with VH were processed for immunohistochemistry. The expression of SMA, CD34, glucose transporter-1 (Glut-1), D2-40, brachyury, angiotensin converting enzyme (ACE), Oct-4, hemoglobin ζ chain (HBZ), Wilms tumor protein (WT-1) and CD45 was examined.

RESULTS

The lymphatic marker, D2-40, was not expressed in VH, whereas Glut-1 was widely expressed in infantile hemangioma, it was only focally expressed by the endothelium of VH. The endothelium of VH expressed the primitive markers, Oct-4, brachyury and ACE. The primitive marker, WT-1, was expressed predominantly on the pericyte layer of both VH and infantile hemangioma. However, HBZ was only expressed in infantile hemangioma. CD45, a mature hematopoetic marker, was expressed by cells within the interstitium, away from the endothelium of VH and infantile hemangioma.

DISCUSSION

The expression of the primitive markers, Oct-4, brachyury and ACE on the endothelium, and WT-1 predominantly on the pericyte layer of VH shows a primitive microvascular phenotype similar to infantile hemangioma. However, the absence of the embryonic marker, HBZ, expressed only in first trimester placenta and in proliferating infantile hemangioma, suggests a different cellular origin. HBZ could be used to distinguish between the two conditions.

Infantile haemangioma expresses embryonic stem cell markers

BACKGROUND

The origin of infantile haemangioma (IH) remains enigmatic. A primitive mesodermal phenotype origin of IH with the ability to differentiate down erythropoietic and terminal mesenchymal lineages has recently been demonstrated.

AIMS

To investigate the expression of human embryonic stem cell (hESC) markers in IH and to determine whether IH-derived cells have the functional capacity to form teratoma in vivo.

METHODS

Immunohistochemical staining and quantitative reverse transcription PCR were used to investigate the expression of hESC markers in IH biopsies. The ability of cells derived from proliferating IH to form teratomas in a mouse xenograft model was investigated.

RESULTS

The hESC markers, Oct-4, STAT-3 and stage-specific embryonic antigen 4 were collectively expressed on the endothelium of proliferating IH lesions, whereas Nanog was not. Nanog was expressed by cells in the interstitium and these cells did not express Oct-4, stage-specific embryonic antigen 4 or STAT-3. Proliferating IH-derived cells were unable to form teratomas in severely compromised immunodeficient/non-obese diabetic mice.

CONCLUSION

The novel expression of hESC on two different populations of cells in proliferating IH and their inability to form teratomas in vivo infer the presence of a primitive cellular origin for IH downstream from hESC.

Family quality of life in 25 Belgian families: quantitative and qualitative exploration of social and professional support domains

BACKGROUND

This article reports on the results of a study conducted in Belgium on family quality of life situated within a larger project focusing on the development of support strategies for young and adolescent siblings of persons with intellectual disabilities. The objectives of this article are twofold: (1) to present the results of the measures contained in the nine domains of the Family Quality of Life Survey-2006 (FQOLS-2006) from the perspective of parents (quantitative analysis); and (2) to come to a more in-depth understanding of two important domains of the FQOLS-2006 by exploring and comparing the quantitative and qualitative data from open-ended interviews with parents.

METHOD

The FQOLS-2006 was completed by the main caregivers of 25 families living in one typical Belgian province. Subsequently, semi-structured interviews with one or both parents were conducted within the same families. Content analysis was carried out on the transcribed interviews using the qualitative software package MaxQDA.

RESULTS

A detailed analysis of the quantitative data together with data from the content analysis of the interviews revealed important issues with regard to two family quality of life domains, support from others and support from services. In general, parents were satisfied with the professional support they received, whereas they were more critical of support from others.

CONCLUSIONS

The quantitative data from the FQOLS-2006 were supported and further explained by the qualitative data. These findings highlight the importance of adequate professional support, which is a flexible and capable answer to each family's individual needs. The authors warn of the dangers of 'handicapism' and plea for a family-centred support approach that takes the whole family into account. Finally, they indicate the benefits of increased practical-pedagogical support.

Single microbubble response using pulse sequences: initial results

The study of acoustic scattering by single microbubbles has the potential to offer improved signal processing techniques. A microacoustic system that employs a hydrodynamically-focused flow was used to detect radiofrequency (RF) backscatter from single microbubbles. RF data were collected using a commercial scanner. Results are presented for two agents, namely Definity (Lantheus Medical Imaging, N. Billerica, MA, USA) and biSphere (Point Biomedical Corp, San Carlos, CA, USA). The agents were insonified with amplitude-modulated pulses, and it was observed in both agents that a subpopulation of microbubbles did not produce a measurable echo from the first-half amplitude pulse, but did produce a response from the full amplitude pulse and from a subsequent half amplitude pulse. The number of microbubbles in this subpopulation was seen to increase with increasing transmit amplitude. These results do not bear out the simple theory of microbubble-pulse sequence interaction and invite a reassessment of signal processing approaches.

Bridging circuit for the resection of retroperitoneal sarcoma involving the aorta and the IVC- veno-venous to veno-arterial perfusion

A 50-year-old female underwent surgery for removal of a massive retroperitoneal sarcoma (RPS) involving the right hepatic lobe and the inferior vena cava (IVC), abdominal aorta, right lung, right hemi-diaphragm and pericardium. Resection of the RPS necessitated cross-clamping of the abdominal aorta, IVC and the hepatic artery. Cross-clamp time cannot be predicted prior to tumour resection and vascular re-construction. To prevent complications of prolonged cross-clamp time and distal hypo-perfusion, circulatory support was sought to facilitate the procedure. A perfusion circuit was designed to accommodate an easy and immediate redirection of blood flow from venovenous bypass (VVB) to veno-arterial bypass (VAB) without requiring a change of circuit and with minimum heparin administration. Furthermore, this circuit provides the added safety of an oxygenator and a heat-exchanger. Utilising the circuit enabled successful resection of the RPS. The patient was discharged from the intensive care unit (ICU) seven days later without any post-operative complications. This case report of a design of a perfusion circuit for the resection of RPS made use of a perfusion approach that had not previously been described and allowed for a reduction in the duration of ischaemic time and retroperitoneal bleeding.

120PREGNANCY RATES RESULTING FROM TRANSFER OF FRESH AND FROZEN HOLSTEIN AND JERSEY EMBRYOS

Although it has not been documented in published studies, embryo transfer (ET) practitioners have suggested that embryos from Jersey (JE) cattle do not survive freezing as well as embryos from other dairy breeds such as Holsteins (HO). The present study represents a retrospective analysis of pregnancy rates achieved following transfer of fresh and frozen embryos from Jersey and Holstein donors. In addition, a retrospective comparison was made of two different embryo-freezing protocols for each breed of cattle. Embryos were collected nonsurgically 7 to 7.5 days post-estrus from superovulated donors on 57 Holstein and 27 Jersey dairy farms over a 15-year period. Fresh and frozen-thawed embryos were transferred nonsurgically into cows and heifers following either natural or prostaglandin-induced estrus. Embryos were frozen either in 10% glycerol (Gly) or 1.5M ethylene glycol (EG) in 0.25mL straws. Following equilibration, straws were seeded at −6 to −7°C and temperature was maintained for 10 min and then decreased at 0.6°Cper min. Straws were plunged into liquid nitrogen at −32 to −35°C. At thawing, straws were held in the air for 7s and then submerged in 29°C water for 15s. Embryos frozen in EG were transferred immediately following thawing. Embryos frozen in Gly were rehydrated in a standard 3-step Gly-sucrose system prior to being transferred. Pregnancy diagnosis was performed at Days 40 to 90 of gestation. As seen in the Table 1, pregnancy rates were similar for fresh embryos from both HO and JE cattle. Also, there were no differences in pregnancy rates between recipients that received embryos frozen in Gly or EG within donors of either breed. However, JE embryos frozen in either Gly or EG resulted in lower pregnancy rates than did HO embryos frozen in Gly or EG. Embryo stage at freezing was tracked for EG but not Gly embryos. There were no differences in pregnancy rates among morulae, early blastocysts or mid-blastocysts for either HO or JE embryos frozen in EG. The differences in embryo survival may be due to different lipid composition of embryos of the two breeds. Perhaps a more efficacious freezing protocol can be developed for cryopreservation of JE embryos. In conclusion, pregnancy rates with cryopreserved HO embryos were higher than with JE embryos. Table 1

Mucus altering agents as adjuncts for nonviral gene transfer to airway epithelium

Nonviral vectors have been shown to be a safe and valid alternative to recombinant viruses for gene therapy of cystic fibrosis (CF). Nevertheless, gene transfer efficiency needs to be increased before clinical efficacy is likely in man. One barrier to increased efficacy is normal airway mucus. Using an ex vivo model of sheep tracheal epithelium, we show that this barrier can, in part, be overcome by treatment with the mucolytic agents, Nacystelyn or N-acetylcysteine using either a cationic lipid or a cationic polymer as the gene transfer agent. Further, in vivo application of either Nacystelyn or the anticholinergic glycopyrrolate, both clinically used agents, resulted in increased reporter gene expression in the mouse lung, but no significant correction of the bioelectric defect in CF null mice. These results, whilst unlikely to be sufficient in themselves to achieve clinically relevant gene therapy, may be a further useful step in the attainment of this goal.

Efficient gene transfer to airway epithelium using recombinant Sendai virus

Clinical studies of gene therapy for cystic fibrosis (CF) suggest that the key problem is the efficiency of gene transfer to the airway epithelium. The availability of relevant vector receptors, the transient contact time between vector and epithelium, and the barrier function of airway mucus contribute significantly to this problem. We have recently developed recombinant Sendai virus (SeV) as a new gene transfer agent. Here we show that SeV produces efficient transfection throughout the respiratory tract of both mice and ferrets in vivo, as well as in freshly obtained human nasal epithelial cells in vitro. Gene transfer efficiency was several log orders greater than with cationic liposomes or adenovirus. Even very brief contact time was sufficient to produce this effect, and levels of expression were not significantly reduced by airway mucus. Our investigations suggest that SeV may provide a useful new vector for airway gene transfer.

The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring

BACKGROUND

To test the hypothesis that certain psychotic symptomatology is due to a defect in self-monitoring, we investigated the ability of groups of psychiatric patients to differentiate perceptually between self-produced and externally produced tactile stimuli.

METHODS

Responses to tactile stimulation were assessed in three groups of subjects: schizophrenic patients; patients with bipolar affective disorder or depression; and normal control subjects. Within the psychiatric groups subjects were divided on the basis of the presence or absence of auditory hallucinations and/or passivity experiences. The subjects were asked to rate the perception of a tactile sensation on the palm of their left hand. The tactile stimulation was either self-produced by movement of the subject's right hand or externally produced by the experimenter.

RESULTS

Normal control subjects and those psychiatric patients with neither auditory hallucinations nor passivity phenomena experienced self-produced stimuli as less intense, tickly and pleasant than identical, externally produced tactile stimuli. In contrast, psychiatric patients with these symptoms did not show a decrease in their perceptual ratings for tactile stimuli produced by themselves as compared with those produced by the experimenter. This failure to show a difference in perception between self-produced and externally produced stimuli appears to relate to the presence of auditory hallucinations and/or passivity experiences rather than to the diagnosis of schizophrenia.

CONCLUSIONS

We propose that auditory hallucinations and passivity experiences are associated with an abnormality in the self-monitoring mechanism that normally allows us to distinguish self-produced from externally produced sensations.

Doppler power spectrum from a Gaussian sample volume

A closed-form expression for the Doppler power spectrum due solely to the range of blood velocities passing through a Gaussian sample volume placed anywhere in a vessel under conditions of axisymmetric flow, uniform backscatter and negligible intrinsic spectral broadening has been derived. The formulation presented here allows the independent specification of the sample volume position and width, in the three dimensions, and enables simple estimations of spectral shape for pulsed wave Doppler systems. Simpler expressions were derived for the cases of symmetric sample volume projections onto the vessel cross-section and/or sample volumes centred in the vessel. Closed form expressions were derived for mean frequency and spectral width in the case of a symmetric sample volume projection centred in the vessel. The effects of sample volume size and position on the Doppler spectral width and mean frequency are shown for a range of velocity profiles.

James Mackenzie Lecture 1980. The compleat general practitioner

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